title: A unique access for the ablation catheter to treat electrical storm in a patient with extracorporeal life support.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation (ECMO) is a very effective bridging therapy in patients with cardiogenic shock. To perform coronary angiography in these patients our group developed an unique system to get urgent vascular access with minimal additional vascular complication risk. The 6 Fr coronary catheters are introduced through a standard Y-connector, which is inserted into the arterial cannula of the ECMO-line close to the patient, the blind end of which is then equipped with a haemostatic valve (Check-Flo Performer accessory adapter, Cook Medical, USA). To the best of our knowledge, we here present the first patient, in whom this system had been used to insert an 8 Fr radiofrequency ablation catheter to treat incessant ventricular fibrillation.
  
  
  RESULTS
  A 66-year-old patient had been transferred with electrical storm 5 days after an acute MI. After failed interventional and medical therapies an ECMO system had been inserted (right femoral artery cannula 15 Fr, left femoral vein cannula 21 Fr) and an electrophysiological study had been performed because of incessant ventricular fibrillation episodes, which always were induced by the same ventricular premature beat (VPB). During this first EP study over the left femoral artery the VPB could be targeted and successfully ablated. Unfortunately the VPB recovered again after some days so a second EP study had to be performed. This time the left femoral artery could not be used because of a postinterventional complication so we used the arterial cannula of the ECMO system as the access for the ablation catheter using a Y-connector. Using this way again a successful ablation procedure could be performed, after getting familiar with manipulation the ablation catheter over the ECMO cannula and with the help of different curved ablation catheters. The issue of compromising of the effective lumen of the arterial cannula by the ablation catheter`s cross sectional area could be overcome with increasing the rotational speed of the V-A ECMO.
  
  
  CONCLUSIONS
  Ablation of ventricular arrhythmias using a Y-connector to insert the ablation catheter into the arterial cannula is feasible in patients with a V-A ECMO system avoiding additional arterial puncture with potentially major vascular complications in critically ill patients. Manipulation of the catheter is not as easy as using a standard sheath but can well be performed after a short habituation.
authors.affiliation: Department of Internal Medicine II Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany.
authors.forename: Ekrem
authors.initials: E
authors.lastname: Ücer
authors.forename: Sabine
authors.initials: S
authors.lastname: Fredersdorf
authors.forename: Carsten
authors.initials: C
authors.lastname: Jungbauer
authors.forename: Kurt
authors.initials: K
authors.lastname: Debl
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.forename: Matthias
authors.initials: M
authors.lastname: Amann
authors.forename: Andreas
authors.initials: A
authors.lastname: Holzamer
authors.forename: Andreas
authors.initials: A
authors.lastname: Keyser
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
authors.forename: Andreas
authors.initials: A
authors.lastname: Luchner
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Günter
authors.initials: G
authors.lastname: Riegger
authors.forename: Dierk
authors.initials: D
authors.lastname: Endemann
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000295:instrumentation*; D054059:Coronary Occlusion / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*
keywords: Ablation; Electrical storm; Extracorporal oxygenation; Ventricular tachycardia